随着医保、医疗和医药信息化的发展,医保经办服务管理逐渐实现信息化、数字化转型。传统的纸质处方流转方式难以满足现代医疗服务需要,以互联网医院为主的医保电子处方流转平台建设与规范化管理已经形成了各方共识。在此背景下,为提高医保经办管理效能,更好满足参保人员就医购药的可及性、便捷性,医保电子处方流转平台的建设应运而生。与传统纸质处方流转效率低、成本高、易出错和处方信息不透明等相比,电子处方流转则表现出了明显优势,为做好参保群众多渠道购药的保障,特别是国谈药“双通道”政策的实施,医保电子处方流转平台建设将有效助推医保经办服务管理效能,增强参保群众的获得感。本文通过对南京市医保电子处方流转平台建设、设计和具体落地实践进行了系统梳理和深入分析,对医保电子处方流转平台运行管理实践成效进行了总结,并对遇到的问题进行分析,提出了以“智联云转”为目标的平台建设建议。

With the advancement of medical insurance, medical treatment, and pharmaceutical informatization, the management of medical insurance services has gradually undergone the transformation of informatization and digitization. The traditional paper prescription circulation method is difficult to meet the demands of modern medical services, and the establishment and standardized management of the medical insurance electronic prescription circulation platform based on the Internet hospitals have gained consensus among all stakeholders. In this context, the construction of the medical insurance electronic prescription circulation platform has emerged in order to enhance the efficiency of medical insurance management and better cater to the accessibility and convenience of medical treatment and drug purchase for the insured. In comparison with the low efficiency, high cost, susceptibility to errors, and lack of transparency in prescription information associated with traditional paper prescription circulation, electronic prescription circulation demonstrates some obvious advantages. To improve multi-channel drug procurement guarantees for the insured with the implementation of national drug negotiation's "dual-channel" policy, constructing a medical insurance drug electronic prescription circulation platform will effectively enhance the efficiency of management services while improving insured individuals' sense of satisfaction. This paper systematically analyzes Nanjing Medical Insurance Electronic Prescription Circulation Platform's construction, design and implementation, summarizes the effects of operating and managing this platform while analyzing the problems, and proposes to construct the platform with a focus on "intelligent connection" and "cloud transfer".